hodgkins lymphoma report

7/29/2019 Hodgkins Lymphoma Report

http://slidepdf.com/reader/full/hodgkins-lymphoma-report 1/34

Prepared by: Marian S. Jalos



LYMPHATIC SYSTEM

Includes the thymus gland , spleen and a network

of lymphatic vessels , lymph nodes and lymph.

This system circulates interstitial fluid and carries

it into the veins . Along the pathway, lymphatic

system filters and destroys pathogens andremoves other potentially harmful substances.



Malignant Lymphoma

Lymphomasare neoplasm of cells of lymphoid origin.

tumors usually start in lymph nodes but can involve

lymphoid tissue in the spleen , GIT (wall of thestomach),liver and bone marrow.

they are often classified according to the degree of cell

differentiation and the origin of the predominant

malignant cell.can be broadly classified into two categories:

Hodgkin’s disease and Non- Hodgkin’s lymphoma.



HODGKIN’S LYMPHOMA ( HODGKIN’S DISEASE )

Thomas Hodgkin an

English Physician first

Describe the disorder in1832; in 20th century,

realization that the

disease is a lymphoid

malignancy led to it

being renamed Hodgkin

lymphoma.

Background



HODGKIN LYMPHOMA (HODGKINS

DISEASE)

Is a malignantdisease of unknown

etiology that

originates in the

lymphoid system and

involves

predominantly the

lymph nodes.It may occur in

nearly any lymphoid

tissue; spleen, bone



Four Major Classification



EXACT CAUSEPREDISPOSING

CAUSES

UNKNOWN

•Exposure tocarcinogens and

viruses•Genetic and

immune

mechanism•Gender (more

common in man)

RRddd



PATHOPHYSIOLOGY

Epstein-Barr Viruscause mutation in some lymphocytes

Creating malignant cell ( Reed Sternberg cell )

abnormal lymphocytes proliferate

Virus inactivate the immune system „s ability to suppress tumor

Malignant cell release chemicals

( cytokines ,histamine )

Inflammatory symptoms

Pain and fever

Generalized itching and skin rash

Leads to immunologic defect

Cachexia (state of ill health , malnutrition , wasting)

Progressive anemia

Respiratory obstruction death



COMPLICATIONS

o ANEMIA

oINFECTIO

No NAUSEAoDEATH



CLINICAL MANIFESTATIONS

o painless enlargement of lymph nodes ( usually on

one side of the neckoSlight to high fever, night sweats , wt.loss („‟B

symptoms‟‟)

oPruritus ( either local or generalized )

oProgressive anemia

o

Enlargement of lymph nodes in other regions of the body

oEnlargement of mediastinal and retroperitoneal

lymph nodes producing pressure symptoms

-Dyspnea from pressure against the trachea

- dysphagia from pressure against the esophagus

- laryngeal paralysis due to pressure against the

recurrent laryngeal nerve.

- brachial, lumbar, or sacral neuralgias due to

pressure on the nerve.

-Edema of the extremities due to pressure on the

veins- enlar ement of s leen and liver



DIAGNOSTIC TEST

o Biopsy of Lymph node

o chest x- ray

o CT scan

o bone marrow biopsy

o

Liver function test andScan

oLymphangiogram

- reveals size of lymph

node-Detects abdominal lymph

node involvement , which

may not be seen on

tomography



STAGES OF HODGKIN‟S DISEASE



NURSING DIAGNOSIS

oRisk for Ineffective

Airway clearance

oRisk for Impaired GasExchange

oRisk for Infection

oActivity IntoleranceoSelf care deficit

oAlteration In Nutrition



MEDICAL MANAGEMENTRADIOTHERA

PYoDelivery of a lethal dose of ionizing

radiation to tumor cells.

oAn important factor in treatment is the

radiation dose administered.oCOMPLICATIONS of INTENSIVE

RADIOTHERAPY: radiation pneumonitis

and fibrosis , pericarditis , nephritis,

myelitis, hypothyroidism and sterility

o

ACUTE REACTION TO RADIATION :dryness of mouth , loss of taste,

dysphagia , nausea and vomiting , apathy

, skin redness, loss of hair at back of neck

and under areas treated , reduction of

WBC



NURSING INTERVENTIONS



Gas Exchange

Assess respiratory status each shift and prn.Note

quality,rate, pattern, depth,flaring of nostrils,dyspnea on

exertion,evidence of splinting use of accessory muscles and

position for breathing.

Any deviat ion from quiet, effort less breathing indicates

comprom ised vent i lat ion

Keep the neck in midline and place the client in high fowlers

position if respiratory distress developAvoiding unnecessary pressure on the trachea and

posi t ioning for increased lung expansion improve air

exchange

Administer oxygen per physician orders if bloos saturationis consistently less than 90%

Reduces def ic i ts in the blood oxygen level .

Place an endotracheal tube,laryngoscope and bag valve

mask at the bedside for intubation

Ensures that medical and emergency assistance are not




Risk for Infection

Restrict visitors or personnel with infections fromcontact with the client

Reduces transm iss ion of pathogens

Practice conscientious hand washing and follow

other principles of medical and surgical asepsisReduces r isk of t ransm itt ing pathogens from one

location to ano ther

Institute infectious disease precautions if normal

WBC are suppressed to dangerous limits.

Protect ive isolat ion technique provide an

env ironmental barr ier against pathogens whi le a

cl ient is highly suscept ib le to disease .

ACTIVITY INTOLERANCE and SELF



ACTIVITY INTOLERANCE and SELF

CARE DEFICIT

Divide care into manageable amounts

Reduces energy expend i tures

Provide rest periods between activities first

Cl ients completes most important or

necessary act iv i t ies whi le energy levels are

highest

Assist client with whatever activities of daily living are independently unmanageable

Reduces the cl ients energy expend i ture




Esophagitis – bland soft foods and mildtemperature,anesthetic lozenges, pain medication before

eating if patient unable to eat.

Loss of taste – serve palatable meals

Anorexia – encourage patient to make the effort to eat.

Nausea and Vomiting – anti emetics given to cover peak

time of nausea.

Diarrhea - anti diarrheal medications

Skin reaction (sunburned/tanned appearance of treatment

area) – avoid rubbing , heat,cold applications of lotionLethargy – rest/sleep to keep energy level up; diversional

activities to prevent boredom

Tingling with numbness in hands , toes , weakness in knees

, hands – use a cane for stability



QUESTIONS

1.Which of the following conditions is not

a complication of Hodgkin’s disease?

A. AnemiaB. Infection

C. Myocardial infection

D. infection



2.At the time of diagnosis of

hodgkin‟s disease ,which of thefollowing areas is often involved

A.BackB.Chest

C.Groin

D.Neck



3.According to a standard staging classification

of Hodgkin’s disease , which of the following

criteria reflects stage II? A. Involvement of extra lymphatic organs or

tissues

B. Involvement of single lymph nodes region orstructure

C. Involvement of two or more lymph nodes

region or structure D. Involvement of lymph node or structures on

both sides of diaphragm



4.Which of the following statements is

correct about the rate of cell growthrelations to chemotherapy?

A.Faster growing cells are less

susceptible to chemotherapyB.Non dividing cells are more

susceptible to chemotherapy

C.Faster growing cells are moresusceptible to chemotherapy

D.Slower growing cells are more

susceptible to chemotherapy



5.A nurse is taking the history from a

client who is suspected of havingHodgkin‟s disease . Which of the

following questions should the nurse

ask to support the diagnosis?A.“ do you wake up sweating during the

night?”

B. “ Do you have difficulty breathingwhile lying flat?‟‟

C.“ have you noticed a lump in your

neck?”



6.What is the best advocate approach to a client who

wishes to discontinue chemotherapy because of complications of the treatment and recurrence of her

cancer , but whose husband wants her to continue

treatment?

A. Encourage the client to discuss her

feelings with you

B. Offer to stay with the client when she talks to her

husband and doctor about her wishesC. Inform the client that she has the right to

discontinue therapy

D. Talk to the healthcare team about the conflict

between the client and her husband



7. To which of the following nursingdiagnoses would a nurse give priority for

a client whose blood test reveals a white

blood cell count of 3000/mm³?A.Risk for activity intolerance

B.Impaired gas exchange

C.Impaired tissue integrityD.Risk for infection



8.A nurse is caring for a client whohas just had endotracheal tube

inserted. Which of the following

actions would the nurse take first?A.Inflate the cuff with appropriate

volumeB.Auscultate for bilateral breath

sounds

C.Tape the tube securely in place



9-10.What are the 3 „B SYMPTOMS OF HODGKIN‟S DI



RATIONALE

1.C.myocardial infarction complications of hodgkin‟s

are pancytopenia,nausea,and infection2.D.at the time of diagnosis a painless cervical

lesion is often present.The back,chest,groin area

arent involved.

3.C.Stage II involves two or more lymph node

region.Stage I only involves one lymph node

regions.Stage III involves nodes on both sides of the

diaphragm.Stage IV extralymphatic organ or tissues.

4.C.the faster the cell grows,the more susceptible it

is to chemotherapy and radiation therapy.Slow

growing and non dividing cells are less susceptible

5 C the earliest manifestation of hodgkin‟s



5.C. the earliest manifestation of hodgkin‟s

disease is usually an enlarged, painless

node in the neck.Hodgkin‟s is a cancer

which originates from the lymph tissue. It isusually starts in a single lymph node or in a

chain of nodes. The lymph tissue undergoes

a malignant transformation which includesinflammation.

6.C.adcocacy is defined as the obligation to

look out ,or to speak up, for the rights of others.The best advocacy approach for the

nurse is to inform this client that has the

right to discontinue therapy despite her



7.C. the normal range for the WBC is

4000-1000µ/ml .Clients exhibiting a low

WBC (leukopenia) are at risk for

infection.

8.A. the first action is to inflate the cuff

so that the tube stays inplace.Afterwards, breath sounds are

auscultated to verify placement.Once

placement is verified,the tube is tape intoplace.

9.The B symptoms are :

Slight to high fe er

hodgkins lymphoma report

Documents